Preoperative assessment of the patient’s mechanical and parenchymal lung function, as well as cardiopulmonary interaction, stratifies the risk of perioperative complications. Anesthesia for lung cancer surgeries involves many challenges including one-lung ventilation (OLV) in patients with limited pulmonary reserve, complex airway management, and critical analgesia to facilitate postoperative recovery. Resectable lung cancers are associated with various regional mass effects, paraneoplastic syndromes, and neoadjuvant therapies which greatly impact anesthetic management. Lung cancer is increasingly common and fatal worldwide. Delayed side effects, e.g., renal toxicity, liver toxicity, leukemia, and myelodysplastic syndrome, occur in a tiny percentage. Another extremely rare side effect reported, not for 111In but for 90Y- and 177Lu-labeled peptides, is “carcinoid crisis” during the infusion or within the first 24 h following it. The extremely rare complications reported after PRRT with 111In-octreotide include acute gastrointestinal side effects occurring within 24 h and subacute hematological toxicity 4–8 weeks after treatment. Peptide receptor radionuclide therapy (PRRT) is generally well tolerated. A great deal of research has been undertaken to understand the angiographic, technical, and safety aspects concerning liver radionuclide-infusion after selective catheterization of the hepatic artery. Adequate use of this therapy requires knowledge and a multidisciplinary cooperation to obtain optimal results and avoid treatment specific complications. Radioactive peptide transhepatic arterial infusion is an effective tool for the treatment of small (less than 20 mm) liver neuroendocrine metastatic tumors and micro-metastases.
#Dr iftikar kullo trial#
Following resuscitation, severe carcinoid heart disease was diagnosed, and the patient subsequently underwent successful surgical valve replacement.Īlthough there is no trial evidence, considering pharmacological rationale and successful outcome in this case, we suggest early administration of intravenous octreotide during resuscitation of patients suffering cardiac arrest post PRRT for carcinoid disease and recommend preventive strategies. She was successfully resuscitated using intravenous octreotide following 22 min of failure to resuscitate with a standard advanced cardiac life support protocol. We report a case of a 58-year old female who suffered from cardiac arrest following PRRT for metastatic carcinoid tumour. Cardiac arrest is an uncommon manifestation of carcinoid crisis and has never been reported as a complication of PRRT. Peptide receptor radionuclide therapy (PRRT) is an effective treatment for metastatic carcinoid tumours but can precipitate a carcinoid crisis through release of stored bioamines.
Note the mass lesions adherent to the walls of the main pulmonary artery (arrows) and extending from the right ventricular cavity and the tricuspid bioprosthesis. Bottom right, D : Long-axis view of the main pulmonary artery (MPA). The tumor in the pulmonary artery was attached to the tricuspid bioprosthesis and extended into the pulmonary outflow tract. The tumor in the superior vena cava originated from the azygos vein and prolapsed into the right atrium. Note the tumor within the superior vena cava (SVC) and the pulmonary artery (PA). Bottom left, C : Short-axis scan at the base of the heart with the transducer adjacent to the posteriorly located left atrium. The azygos vein is filled with tumor mass. Top right, B : Long-axis view of the descending thoracic aorta (Ao) and the azygos vein (arrows) running parallel to the surface of the thoracic aorta. The tumor extends out the right ventricular outflow tract.
The right atrial cavity is nearly filled by multiple fronds of the tumor extending through and attached to the PV (arrow). Top left, A : Transgastric long-axis view of the right ventricle (RV) and bioprosthetic tricuspid valve (PV, arrowheads ). Transesophageal echocardiographic features of intracardiac leiomyomatosis in case 2.
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